Hands up who’s noticed many changes to their sleep during perimenopause? Uh-huh. You might’ve been a Class A, super-dooper sleeper most of your life. You know, straight to sleep before your head hits the pillow and out like a light for the whole night! Well, welcome to perimenopause (and beyond), when even the best sleepers aren’t immune to some form of disruption, at some point in the transition.

In fact, research tells us around 40% of us will have insomnia at some point of the transition to menopause. Some studies report that its more like around 60% that experience insomnia in perimenopause.

Insomnia?! Wait, what?

Yep, insomnia is defined as any one (or more) of these symptoms, that occur for three or more nights/week, over three or more consecutive months:

  • Taking a long time to go to sleep (‘initiating’ sleep);
  • Increased waking through the night after going to sleep (‘maintaining’ sleep);
  • Waking early in the morning; or
  • Not feeling refreshed, despite having adequate opportunity for sleep.
Yes, your struggle is real! And you’re not alone (which is somewhat comforting,) but still, so many of you are going about your day in a state of sleep deprivation! Let me explain why this happens, and I’ve got some tips on what you can do to help improve your sleep during perimenopause (and beyond).

Perimenopause as a ‘second puberty’

The hormonal changes of perimenopause can be just as dramatic as the ones you go through as a teen. Potentially, there may be less leeway, patience, empathy or understanding given to you as you navigate this time – when it can feel like you’re in someone else’s body.


menopause humor

Life is a roller-coaster

While menopause is a time of low oestrogen, the period before menstruation ceases – perimenopause – is an oestrogen roller-coaster. This ride isn’t always fun! Oestrogen surges up higher than it has before, and plummets down lower than low. While all this is going on, progesterone (which counter-acts oestrogen) is slowly declining.

If all that wasn’t enough, your androgens (eg testosterone) decrease as we age, and by the time you’re in your 40s, they’re half what they were in your 20s. What does that mean? Well, low testosterone has been linked with low libido, mood and stamina. So, you need good sleep more than ever, but it’s harder to get!
How you experience this ride depends a lot on your body’s ability to adapt to the up and down of oestrogen. Stress levels and your stress resilience (ability to withstand stress) are major factors in this. I’ll talk more about this in another blog. In the meantime, you can download my free eBook to get a good understanding of how to support your body and build stress resilience.

Let’s explore how these hormonal changes impact your quality and quantity of sleep.

Hormonal changes and your sleep during perimenopause

Progesterone is a calming hormone. It balances the assertiveness and boldness that oestrogen brings us. It has sedative and anti-anxiety (anxiolytic) effects, while also stimulating benzodiazepine (calming) receptors in the brain, which are really important for getting and staying asleep.

I guess you could thank low progesterone when you’re lying in bed worrying about E.V.E.R.Y.T.H.I.N.G. that wasn’t important enough to worry about during the day. hmmm

Extreme drops in oestrogen, and ongoing lower levels of oestrogen, seem to impact sleep by altering neurotransmitter levels in the brain. The fluctuation of oestrogen seems to impact serotonin, dopamine and noradrenalin too. These are important for regulating mood, motivation, sleep, pleasure and your circadian rhythm.

I’ve talked before about neurotransmitters and how they drive cravings, mood and motivation. But they’re also super important for sleep. Serotonin and melatonin are the main sleepy neurotransmitters, and lower levels of serotonin and/or poor conversion to melatonin mean that it is hard for you to get to sleep initially or during the night if you’re disturbed by things like hot flushes.

You say flashes, I say flushes…

Not everyone experiences hot flushes, but many women (me included!) will say they feel hotter than they used to. I hear from many women that they used to be the ‘cold person’ in their relationship. You know, the one needing an extra blanket or quilt at night. That was until perimenopause came along, and now they’re having a hard time sleeping when its anything other than arctic temps in the bedroom!

So hot flushes can definitely wake you up, and then make it hard to go back to sleep. Women experiencing hot flushes usually wake multiple times and may take a long time to get back to sleep afterwards.

Also feeling hotter ‘all the time’ makes it harder to go to sleep too. This is because your body relies on a drop in temperature to signal that you’re ready for sleep. Sometimes it’s really hard to get the temp drop when you’re in perimenopause. Especially when your pet thinks you’re a great hot water bottle and always wants to be right next to you. I love you too cat but go away!

Why does this happen? Well, hot flushes (or vasomotor symptoms as they’re called) aren’t just from changes to oestrogen, but other hormones (like luteinising and follicle-stimulating) and increased activity in the brain (hypothalamus). It’s also thought that the changes in neurotransmitters may contribute to hot flushes.

Stress levels impact your sleep during perimenopause

It wouldn’t be a blog if I didn’t mention stress! But like most things, stress makes sleep during perimenopause worse for a number of reasons.

Hot flushes become worse when women are stressed, over-worked or sleep deprived. Well, that just described almost every woman I know. This is because your body’s response to stress is controlled in the same part of the brain as your ovaries and reproductive hormones. Increased activity in the hypothalamus = increased heat, or hot flushes in your body.

When the amount of oestrogen your ovaries are making is declining, your body relies on your adrenal glands to kick in and make some oestrogen. If your adrenal glands are busy responding to stress, they prioritise making cortisol over oestrogen. Cortisol and progesterone are also made from the same backbone, so stress levels may impact progesterone levels over time.

5 things you can do to improve your sleep during perimenopause

So now I’ve given you all the ways sleep goes wrong, I better give you some tips on how to help get your sleep back on track, right? Ok, let’s do it.

1. Move your body each day

Yoga, meditation and exercise are essential stress management tools. But moving your body, doing something you enjoy (IE not as a punishment for what you’ve eaten!), is also an important tool for overall health and well-being and to help reduce the symptoms of perimenopause.

Remember, it doesn’t have to be grand gestures, but small amounts, done regularly, will equally benefit your body.

2. Eat a whole foods, plant-based diet

Rich in healthy fats, protein and phytoestrogens like flaxseeds, alfalfa sprouts, chickpeas, prunes, passionfruit, peanuts, raisins, and red clover. If you want to know what the heck I mean when I say, ‘ healthy diet’, then read this blog please.

3. Manage your stress levels

I’ve got loads of tips and tricks on my blog about how to do this. Usually, the first step is to start saying NO. It’s hard, I know, but really, really important. Find some ideas here  or download my free eBook.

4. Avoid stimulants like coffee, sugar and alcohol

These drinks impact hormone levels, your body’s stress response, liver function, nervous system health, and neurotransmitter balance. I hope you’ve hung out with me here long enough to understand how it may impact your health, but if not, please go back at look at my blogs about cravings, stress, and caffeine.

4. Dress lightly for bed

And use bedding that allows you to easily adjust your temperature if you do get hot or cold during the night. I recommend pure wool or cotton blankets for a healthier sleep and less sweating.

5. Develop a nightly routine

This helps get you in the mood for sleep while also supporting your body to get that temperature drop. Your body loves rhythm and regularity. Help it out by implementing a bedtime ritual that soothes your nervous system and helps facilitate the temperature drop your body needs to get to sleep.

For example, use low lights or small lamps after dinner, choose reading over watching TV/phone. Enjoy a cup of Zen Glow or chamomile tea to help relax your nervous system. And then have an Epsom salt bath, or warm shower just before you get in to bed.

Bonus Tip Number 6

Talk to your friendly naturopath. There is much that personalised herbal and nutritional medicine can do to help support and ease the transition from perimenopause to menopause. When you work with a naturopath you save time, money and effort as you get the value of their knowledge and experience to help pick the most effective treatment for your symptoms, lifestyle and body.


Before you go

Other factors such as sleep apnoea, snoring, restless leg syndrome, pain, chronic illnesses, and lifestyle factors may be contributing to your insomnia or poor sleep during perimenopause. Lifestyle factors include things like caffeine and alcohol intake, poor sleep hygiene, snoring partner, pets, kids, irregular schedule, night shift, etc. Please do chat with a health professional to make sure there isn’t something else at play for you.

Disrupted sleep is inevitable at different stages of life, especially if you’re a Mum. However, it doesn’t need to become a nightly occurrence, or something that you accept as normal for the whole of perimenopause. (Yes it’s common, but that doesn’t make it normal!) You can get on top of insomnia and get back to sleeping ‘like a baby’. (Well, better than a baby, because who said that anyway?! My babies sure didn’t get that memo!) Sleep during perimenopause can be plentiful and restful.

Would you like a personalised insomnia or perimenopause management plan? I offer a 12-week holistic, 1:1 perimenopause management program that gives you the tools and knowledge to build stress resilience, hormonal health and set yourself up with healthy habits for a smoother transition to menopause. If you’d like to know more, then please book a time for a free chat or send me an email at info@akesohealthcare.com.au.